Provider Demographics
NPI:1154305985
Name:RACKOW, BETH WENDY (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:WENDY
Last Name:RACKOW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:622 W 168TH ST PH 16-126
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:122-305-1107
Mailing Address - Fax:212-305-6125
Practice Address - Street 1:51 W 51ST ST STE 320
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1951
Practice Address - Country:US
Practice Address - Phone:212-305-1107
Practice Address - Fax:212-305-6125
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY263158207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001422188Medicaid
I08114Medicare UPIN
CT001422188Medicaid